VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Journeys Crossing
102 N. Stuart Avenue
Elkton, VA 22827
(540) 298-0054

Current Inspector: Jeffrey Marnien (540) 571-0189

Inspection Date: March 23, 2020

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 PERSONNEL 22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 ADMISSION, RETENTION, AND DISCHARGE OF RESIDENTS 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 RESIDENT ACCOMODATIONS AND RELATED PROVISIONS 22VAC40-73 EMERGENCY PREPAREDNESS 63.2 Protection of adults and reporting.

Comments:

This inspection was conducted in response to a complaint that was received in the licensing office on 03/19/20 relating to the allegation of verbal abuse to a resident by a staff member, inadequate staffing and non-reported incidents of bed bugs and Scabies. The information gathered during this complaint investigation supports the allegations, so the complaint is determined to be valid. There are eight violations resulting from this complaint investigation. Details of non-compliance can be viewed in the violation notice section of this report. Please complete the columns for "description of action to be taken" and "date to be corrected" for each violation cited on the violation notice, and then return a signed and dated copy to the licensing office within 10 calendar days of receipt. If you have any questions, please contact the licensing inspector at (540) 332-2330 or rhonda.whitmer@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-70-A
Complaint related:	Yes
Description:	Based upon communication and a review of documentation, the facility failed to report to the regional licensing office within 24 hours, any major incident that has negatively affected or that threatens the life, health, safety or welfare of any resident. EVIDENCE: 1) Based upon communication with the administrator on 03/23/20, the facility had evidence of bed bugs on 11/29/19 in two resident rooms. a. Based upon communication with the administrator on 03/23/20, evidence of bed bugs were found by pest control in two resident rooms on a follow-up visit on 01/31/20. b Based upon communication with the administrator on 03/23/20, three resident rooms were treated by pest control agency on 02/12/20 and 02/13/20 in addition to all common areas and hallways. c. Based upon communication with the administrator on 03/24/20, staff reported possible bed bug sighting on 03/19/20 and pest control agency has not been to the facility. 2) Based upon communication with the administrator on 03/23/20, a resident was identified as having scabies. 3) Based upon communication with the administrator on 03/23/20 and a review of documentation dated 03/19/20, staff A verbally abused resident B on 03/19/20. 4) Based upon documentation received on 03/26/20 a physical altercation occurred between D and E on 03/17/20 resulting in bruising to resident D.
Plan of Correction:	Regional Administrator has reviewed the reporting regulations and policies with the facility administrator. Facility Administrator will report to the regional licensing office within 24 hours as indicated by DSS regulations and facility policies.
Standard #:	22VAC40-73-70-C
Complaint related:	Yes
Description:	Based upon communication and a review of documentation, the facility failed to submit a written report to the regional licensing office within seven days, any major incident that has negatively affected or that threatens the life, health, safety or welfare of any resident. EVIDENCE: 1) Based upon communication with the administrator on 03/23/20, the facility had evidence of bed bugs on 11/29/19 in two resident rooms. a. Based upon communication with the administrator on 03/23/20, evidence of bed bugs were found by pest control in two resident rooms on a follow-up visit on 01/31/20. b Based upon communication with the administrator on 03/23/20, three resident rooms were treated by pest control agency on 02/12/20 and 02/13/20 in addition to all common areas and hallways. c. Based upon communication with the administrator on 03/24/20, staff reported possible bed bug sighting on 03/19/20 and pest control agency has not been to the facility. 2) Based upon communication with the administrator on 03/23/20, a resident was identified as having scabies. 3) Based upon communication with the administrator on 03/23/20 and a review of documentation dated 03/19/20, staff A verbally abused resident B on 03/19/20.
Plan of Correction:	Regional Administrator has reviewed the reporting regulations and policies with the facility administrator. Facility Administrator will submit a written report to the regional licensing office within seven days of the incident as indicated by DSS regulations and facility policies.
Standard #:	22VAC40-73-130-B
Complaint related:	Yes
Description:	Based upon review of resident's record, communication and documentation, the facility failed to ensure a resident's contact person or legal representative was notified when a report was made that a resident had been verbally abused by staff. EVIDENCE: 1) Documentation dated 03/19/20 indicates resident B was verbally abused by staff A on 03/17/20. 2) The LI interviewed the administrator on 03/24/20 and she communicated that she did not report this incident to the family.
Plan of Correction:	Facility Administrator will assure that all proper communication and documentation has occurred to the resident?s contact person or legal representative. Documentation will be filed in resident?s chart.
Standard #:	22VAC40-73-280-A
Complaint related:	Yes
Description:	Based upon review of facility schedule, communication with the administrator and review of resident records, the facility failed to ensure there are staff adequate in knowledge, skills, and abilities and sufficient in numbers to provide services to attain and maintain the physical, mental, and psychosocial well-being of each resident as determined by resident assessments and individualized service plans. EVIDENCE: 1) Based upon a review of the facility schedule dated 02/28/20 through 03/13/20, there were only two staff working third shift 02/28/20 through 03/08/20. 2) Based upon review of the facility schedule dated 03/13/20 through 03/26/20, there were only two staff members on third shift 03/13/20 through 03/25/20. 3) Communication received from the administrator on 03/23/20 indicate there are seven residents in the facility with a serious cognitive impairment and only two of the seven are physically ambulatory and four of those require two person assistance. a. The ISPs reviewed for residents A and B indicate they require 2 person assistance for transfers. b. At the time of this inspection, there are 35 residents in care.
Plan of Correction:	Facility Administrator will hire staff for the overnight ?3rd shift? to increase to three employees each night for the current case load. Staffing for the overnight ?3rd shift? will increase or decrease based on level of care.
Standard #:	22VAC40-73-280-C
Complaint related:	Yes
Description:	Based upon review of facility schedule, communication with the administrator and review of resident records, the facility failed to ensure there are an adequate number of staff persons on premises at all times to implement the approved fire and emergency evacuation plan. EVIDENCE: 1) Based upon a review of the facility schedule dated 02/28/20 through 03/13/20, there were only two staff working third shift 02/28/20 through 03/08/20. 2) Based upon review of the facility schedule dated 03/13/20 through 03/26/20, there only two staff members on third shift 03/13/20 through 03/25/20. 3) Communication received from the administrator on 03/23/20 indicate there are seven residents in the facility with a serious cognitive impairment and only two of the seven are physically ambulatory and four of those require two person assistance. a. The ISPs reviewed for residents A and B indicate they require 2 person assistance for transfers. b. At the time of this inspection, there are 35 residents in care.
Plan of Correction:	Facility Administrator will hire staff for the overnight ?3rd shift? to increase to three employees each night for the current case load. Staffing for the overnight ?3rd shift? will increase or decrease based on level of care.
Standard #:	22VAC40-73-440-D
Complaint related:	No
Description:	Based upon review of residents' records, the facility failed to ensure the Uniform Assessment Instrument (UAI) is complete and accurate. EVIDENCE: 1) The UAI for resident A indicates assessment date of 11/20/2020. a. The section indicating whether assistance is required with stair climbing is not complete. 2) The UAI for resident B indicates assistance is needed with stair climbing; the section indicating stair climbing is not performed is checked. 3) The UAI for resident C indicates a re-assessment date of 01/27/20. The most recent signature of assessor is dated 01/17/19 which was the original assessment date.
Plan of Correction:	Facility Administrator and the Regional Administrator will review all UAIs for completeness, correctness, and that the UAI and ISP match. A ?double check? process will be completed on all future UAIs for new admissions, yearly reviews, or significate changes by the Facility Administrator and her designee.
Standard #:	22VAC40-73-450-C
Complaint related:	No
Description:	Based upon review of residents' records, the facility failed to ensure all assessed needs of the resident are included on the Individualized Service Plan. EVIDENCE: 1) The ISP for resident A indicates allergies to Sodium Chloride, Potassium and Alprazolam. Description of reaction(s) is not identified. 2) The UAI for resident B indicates Abusive/Aggressive/Disruptive behaviors. There are no interventions identified. The ISP indicates "staff to re-direct to the best of their abilities." a. The UAI indicates resident is disoriented to some spheres all the time. ISP indicates disorientation to some spheres all the time; spheres and interventions are not identified. 3) The UAI for resident C indicates assistance is needed with stair climbing and section is indicated that stair climbing is not performed. The ISP indicates resident can climb stairs but does not identify supports needed. 4) The UAI for resident C indicates Abusive/Aggressive/Disruptive behaviors. There are no interventions identified. The ISP indicates "staff to try and re-direct resident." 5) The UAI for resident E indicates resident is disoriented to all but self. ISP indicates resident is disoriented to real time, place an person. There are no interventions indicated on the ISP. a. The ISP indicates resident has an allergy to Morphine but indicates (unknown reaction.)
Plan of Correction:	Facility Administrator and the Regional Administrator will review all ISPs for completeness, correctness, and that the ISP and UAI match. A ?double check? process will be completed on all future ISPs for new admissions, yearly reviews, or significate changes by the Facility Administrator and her designee.
Standard #:	22VAC40-73-680-D
Complaint related:	No
Description:	Based upon review of resident records, the facility failed to ensure medications are administered in accordance with the physician's instructions and consistent with the standards of practice outline in the current registered medication aide curriculum approved by the Virginia Board of Nursing. EVIDENCE: 1) Resident A has the following order: Check weight daily. Report if gain of three pounds in 24 hours or five pounds in one week. a. Documentation in the electronic Medication Administration Record (MAR) indicates resident's weight was 128.6 on 03/06/20. b. Documentation indicates resident was hospitalized 03/07/20 through 03/16/20. c. Documentation indicates resident refused weights on 03/17/20, 03/18/20, 03/20/20 and 3/21/20. d. Documentation indicates resident's weight was 193.6 on 03/19/20, 193.6 on 03/22/20 and 194 on 03/23/20. e. Communication with the administrator on 03/25/20 indicates the physician had not been notified of refusals. f. Communication with the administrator on 03/25/20 indicates weight discrepancy is due to resident being weighed while in wheelchair. 2) Resident D has the following order effective 01/06/20: Morphine Sulfate ER 15mg tablet-Take one tablet by mouth two times a day for pain. a. There is an additional order in the MAR for Morphine Sulfate ER 15mg tablet-Take one tablet by mouth two times a day for pain. b. Documentation in the MAR indicates medication was given from both orders on 03/12/20 at 9:00am, and on 03/13/20 at 9:00am and 6:00pm. c. The MAR also indicates duplicate orders for Oxycodone 10-325 to be given once a day as needed for RA.
Plan of Correction:	Facility electronic medication administration records (eMARs) has been set up to alert Facility Administrator if weight gain of greater than three (3) pounds. Facility administrator will verify the alert and address with Registered Medication Aide and assure that the physician has been notified. Notification will be documented and filed in resident?s chart. Facility electronic medication administration records (eMARs) has been set up to alert Facility Administrator if a medication or treatment has been marked as refused. The Facility Administrator will verify that a ?Medication/Treatment Refusal Form? has been completed and the physician has been notified. The Medication/Treatment Refusal Form will be filed in the resident?s chart. This will be completed by 03/30/20. The Facility Administrator will refresh all Registered Medication Aides on how to properly document on the eMAR. The Facility Administrator will re-inservice all Registered Medication Aides in proper notification and documentation. Training will be completed by 04/30/20.